Open Source Software and the Electronic Health Record

Open Source Software
and the Electronic
Health Record: An
Ralph La Tella HIM
What is Open Source
Software whose code is released openly
without traditional licensing restrictions
Source code (computer program) may be
modified or improved by user of the software
and then re-distributed
Some call it “free software” but the only
freedom you have is to be able to modify it
The reality is that a lot of it is actually “free” or
available at a very low cost
Examples of Open Source
Fire Fox web browser
Moodle e-learning
MySQL Relational
Database Management
GIMP (Open Source
version of PhotoShop)
PSPP – Free alternative
Typical Open Source Platforms
for EHRs
Are web-based and delivered to your PC
through your internet browser
Hosted on an Open Source server: usually
Linux-based and (although can be done in
Windows) called APACHE (OSS)
Use a programming language called PHP
Use a widely implemented database
application called MySQL (OSS)
Open Source EHRs: Framework
Open Source EHRs
OpenEMR (available online at
Click here to demo on a live server install
Some features:
Practice Management features for patient scheduling, patient
Electronic Medical Records - creating an on-line record of
patient encounters
Ability to enter CPT and ICD codes at the end of a patient
Advanced reporting capabilities
Prescription writing capability with ability to email or print
HL7 support to parse HL7 messages
Open Source EHRs
OpenVista (Veteran’s Affairs USA) – login screen:
OpenVista Patient summary
OpenVista – w/PACS module
Open Source EHRs
To Cut Cost$
Open Source EHRs - Why?
The High Cost associated of proprietary EHRs
 Recent research in the USA reveals that only 1.5% of
hospitals there have a comprehensive EHR system
in place (Jha et al. 2009)
The same study also pointed to capital costs as the
single biggest barrier to the adoption of the EHR in
the hospitals surveyed (n= 3049) with maintenance
costs cited as the next major barrier to EHR
Why Open Source EHRs? –
“The open source software (OSS) approach to
EHR implementation represents a promising
and affordable alternative, increasing the
overall cost-effectiveness of healthcare IT
without sacrificing performance and patient
safety.“ (Vlaicu, 2009).
Why Open Source EHRs? –
There are almost 30 million health records
created using OSS in the USA.
Recognising the importance of nonproprietary and Open Source software as a
potential solution to the EHR, the Department
of Health and Human Services has been
commissioned a study to report on the
subject by 2010. (Vlaicu, 2009).
Why Open Source EHRs? –
“Open Source is the only way that the (US)
administration can drive health care IT
adoption.” (Vaughn-Nichols 2009)
Gartner (USA) has predicted that:
 By 2010, 90 percent of Global 2000 organizations will have
formal open-source acquisition and management strategies.
By 2009, OSS solutions will directly compete with closed-source
products in all software infrastructure markets.
By 2010, open source will be included in mission-critical software
portfolios within 75 percent of Global 2000 enterprises.
By 2010, Global 2000 IT organizations will consider open-source
products in 80 percent of their infrastructure-focused software
investments and 25 percent of business software investments
OSS, EHRs & the HIM
HTML Data Entry Form
Admin entry
Clinical notes
Form Validation
Business/Clinical Logic
Dynamic Results fed back
to HTML Data Entry form
Database Server/
Application Server
Opportunities for HIMs in the
Implementation of OS EHRs
OSS EHRs may be modified/customised
according to specific requirements – asset
Core modules rely on HTML forms to effect
data entry – forms design using Web 2 tools
eases the forms design process (little/no
programming required)
Forms “connect” to the application using
business logic that may be modified
according to user’s needs
Opportunities for HIMs
Data verification logic – a new field for
existing HIM skills
Application modules are database-driven
using OS industry standard software such as
MySQL – fully SQL compliant – easy to learn
database especially for those with experience
using MS SQL server
Capacity to gain sought-after Internet/web
security skills
Opportunities for HIMs
Apply medico-legal expertise to the
development of standards governing
jurisdictional issues – who owns the EHR
since the application “driving” it is in the
Public Domain (i.e. Open source)
Issues & Considerations
The usual:
The unusual:
Privacy & Confidentiality (esp. with distributed systems)
Ownership & Governance (esp with PCHRs)
Where does the buck stop?
 Free software but maintenance an issue
 End user training – the hidden costs
 Who do you turn to for support – Forums?
 Modified software – a legal minefield?
The perfect opportunity for the enterprising HIM to
get in on the ground floor!
The End……of the beginning?

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